AB0221 DIFFICULT-TO-TREAT RHEUMATOID ARTHRITIS IN THE CLINICAL PRACTICE OF A RHEUMATOLOGY CENTER
Authors: A. Gordeev, E. Matianova, Y. Olyunin, E. Galushko
Journal: Annals of the Rheumatic Diseases (2022)

Objectives To compare the features of the disease course and the therapy in rheumatoid arthritis (RA) patients who meet and do not meet the difficult to treat (D2T) criteria. Methods RA patients admitted to the V.A. Nasonova Research Institute of Rheumatology for therapy correction from March to October 2021were included. All patients fulfilled the RA criteria of ACR/EULAR 2010. According to the opinion of the attending physician, they needed correction of therapy, so they were sent to the expert commission to confirm the expediency of using biologic or targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARDs). Results 295 RA patients with high or moderate disease activity according to DAS28 were included. The expert commission in all cases confirmed the validity of administration of biologic or ts DMARDs. 111 (37.6%) patients (group A) were prescribed these drugs for the first time due to the unsatisfactory result of the use of conventional synthetic (cs) DMARDs, 105 (35.5%) patients were planned to continue treatment with previously used biologic or ts DMARDs after a break associated with various reasons (group B). In 54 (18.3%) cases, first biologic or ts DMARD failed so second biologic or ts DMARD was prescribed (group C). The D2T group included 25 (8.4%) patients with a history of inefficiency or intolerance of 2 or more biologic or ts DMARDs of different mechanisms of action. The duration of RA in the D2T group was significantly longer than in the rest of the patients (respectively 15.9±11.8 and 11.9±9 years, p=0.04). Radiological changes of joints in D2T RA were more significant than those in the rest of the patients. The III or IV Steinbrocker stage og RA in the D2T group was detected in 18 (72%) while in the remaining patients - in 130 (48.1%) cases (p=0.02). At the same time, there was a correlation between the duration of RA and the X-ray stage (p&lt;0.0001). At the time of hospitalization, patients with D2T had higher inflammatory activity than group B patients who continued therapy with biologic or ts DMARDs. In groups A and C, all the analyzed signs of inflammation were also significantly higher than in group B (p &lt;0.05). Methotrexate had been most often prescribed as the first cs DMARD in all groups but at the time of hospitalization, patients with D2T RA were more likely than other patients to remain without DMARDs (in 8 (32%) and 39 (14.4%) cases respectively, p=0.03). 73.3 - 84% of patients in all groups earlier received glucocorticoids (GC). At the time of hospitalization, the dose of GC in D2T group was higher than in other patients and averaged 8.3±5.1 mg /day and 6.4±2.9 mg / day, respectively, p=0.02. The proportion of patients taking GC in the D2T group was also higher than that among other patients, but these differences did not reach statistical significance. In D2T RA, adverse events associated with biologic DMARDs occurred more often than in groups B and C (respectively in 9 (36%) and 15 (9.4%) patients; p=0.001). Conclusion The formation of D2T RA in our patients could be associated with the prescribing of higher doses of GC and insufficient use of DMARDs. The development of D2T RA was accompanied by a more pronounced progression of radiological changes of the joints than in other patients. Disclosure of Interests None declared